What are the ethical issues involved in private, physician-owned hospitals?

The OrthoIndy website stated the following:

OrthoIndy provides complete bone, joint, spine and muscle care. With more than 60 orthopaedic specialist partners, OrthoIndy is the largest private, fullservice orthopaedic practice in the Midwest, and one of the largest in the country.

(OrthoIndy 2018)

OrthoIndy adjusted its practice over time. For years, its physicians took patient emergency calls for all area hospitals and provided services to all types of patients. However, as the market became more competitive and physician incomes declined slightly, it decided to reduce calls to only key facilities (Methodist and St. Vincent) and stopped treating Medicaid patients.

This decision upset most of the area hospitals and the nonaffiliated orthopedists, and some of OrthoIndy’s partners were concerned about the ethical and political ramifications, but ultimately they all agreed to the decision.

Although these choices improved the incomes and lifestyle of the practicing physicians, significant concerns existed about what could be done to sustain their salaries. OrthoIndy therefore turned its attention to the large surgical center it owned, which was quite profitable, and to other possible facilities that could provide them additional earnings.

OrthoIndy felt that its mission lent itself to opening its own hospital so it could better be the leader in advancing quality bone, joint, spine, and muscle care and technology. Its physicians felt that with their own hospital OrthoIndy could become one of the most highly respected orthopedic practices in the Midwest.